Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosing and administration, and place in
therapy of
avatrombopag for the treatment of
immune thrombocytopenia and chronic
liver disease-associated
thrombocytopenia. Summary:
Avatrombopag is an orally administered
thrombopoietin receptor agonist approved for the treatment of
immune thrombocytopenia and is the first oral
thrombopoietin receptor agonist approved for the treatment of perioperative
thrombocytopenia associated with chronic
liver disease in adults. The efficacy and safety of
avatrombopag has been demonstrated in a multicenter, randomized, double blind, placebo-controlled phase III study in the setting of
immune thrombocytopenia and in 2 identically designed, multicenter, randomized, double blind, placebo-controlled phase III trials in the setting of
thrombocytopenia associated with chronic
liver disease. The most common adverse events reported in the clinical trials were
headache,
fatigue, and gastrointestinal toxicities. The incidence of
bleeding events was comparable between the
avatrombopag and placebo treatment groups in each study.
Avatrombopag has not been shown to be associated with hepatoxicity and does not require food restriction like the other oral
thrombopoietin receptor agonist for
immune thrombocytopenia,
eltrombopag. Also, unlike
eltrombopag for
immune thrombocytopenia, it can be dosed less frequently than once daily. Conclusion:
Avatrombopag offers another safe and effective oral option for the treatment of
immune thrombocytopenia without food restrictions and an alternative, transfusion-sparing option for
thrombocytopenia associated with chronic
liver disease patients undergoing surgery.